Journal Article Ahead of print 1 citation
PubMed: 42765693 DOI: 10.1227/neu.0000000000004213
Simpson Grading and Risk of Recurrence in 4074 Meningioma Patients With Gross Total Resection.
Neurosurgery
Authors: Christian Mirian, Lasse Rehné Jensen, Adam Gorm Hoffmann, Andrea Daniela Maier, Tareq A Juratli, Sverre H Torp, Helen A Shih, Ramin A Morshed, Jacob S Young, Stephen T Magill, Luca Bertero, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Soichi Oya, Satoru Miyawaki, Nobuhito Saito, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Jennifer Moliterno, Ricardo Prat-Acin, Stéphane Goutagny, Vikram C Prabhu, John T Tsiang, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W Kim, Matthew Koshy, Karthikeyan Perumal, Mustafa K Baskaya, Donald M Cannon, Dennis C Shrieve, Chang-Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, Ilker Y Eyüpoglu, Tony Catalan, Austin Lui, Philip V Theodosopoulos, Michael W McDermott, Pedro Góes, Manoel Antonio de Paiva Neto, Ricardo Komotar … and 25 other authors
Affiliations
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Division of Neuro-Oncology, Department of Neurosurgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Department of Neurosurgery, Laboratory of Translational Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Laboratory Centre, St. Olavs Hospital, Trondheim, Norway.
- Department of Pathology, Laboratory Centre, St. Olavs Hospital, Trondheim, Norway.
- Department of Radiation Oncology, Mass General Brigham Cancer Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.
- Pathology Unit, Department of Medical Sciences, University and Città della Salute e della Scienza University Hospital of Turin, Turin, Italy.
- Department of Neurosurgery, University of Münster, Münster, Germany.
- Institute for Neuropathology, University of Münster, Münster, Germany.
- Deparment of Neurosurgery, Clemenshospital Münster, Münster, Germany.
- Department of Neurosurgery, Saitama Medical Center/University, Saitama, Japan.
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
- Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany.
- Department of Neurosurgery, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan.
- Department of Neurosurgery, Athens Medical Center, Athens, Greece.
- EUC Athens Medical School, Athens, Greece.
- Department of Neurosurgery, Bethel Clinic University of Bielefeld Medical Center, Bielefeld, Germany.
- Department of Neurosurgery, Yale School of Medicine, Yale New Haven Hospital, Smilow Cancer Hospital, New Haven, Connecticut, USA.
- Department of Neurosurgery, Hospital La Fe, Valencia, Spain.
- Department of Neurosurgery, Université Paris Cité, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA.
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.
- Department of Neurosurgery, University of Wisconsin Medical School and Public Health, Madison, Wisconsin, USA.
- Department of Radiation Oncology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
- Division of Neurosurgery, Miami Neuroscience Institute, Miami, Florida, USA.
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA.
Abstract
BACKGROUND AND OBJECTIVES
Simpson grading remains the most widely used clinical classification of extent of resection in meningioma surgery, yet its relevance in modern neurosurgical practice remains debated. The aim was to evaluate whether Simpson grading is associated with recurrence risk after gross total resection (GTR) of intracranial meningiomas within the context of tumor biology and anatomic location.
METHODS
We analyzed 4074 patients undergoing GTR (Simpson grades 1-3) for primary intracranial meningioma, compiling data from 42 institutions worldwide. Cumulative incidence of recurrence was estimated using Aalen-Johansen methods. Multivariable inverse probability of censoring weighted logistic regression models were used to estimate adjusted recurrence risks at 5 and 10 years, adjusting for age, sex, World Health Organization (WHO) grade, Ki-67 proliferation index, and healthcare system setting.
RESULTS
Higher Simpson grades were consistently associated with increased recurrence risk in WHO-1 and WHO-2. Among WHO-1, Simpson grade 2 had more than twice the recurrence odds compared with grade 1 at 5 years, whereas grade 3 showed even higher odds ratio of 3.47 (95% CI, 1.98-6.08). Similar patterns were observed in WHO-2 tumors. Interaction analyses suggested that differences between Simpson grades increase with higher Ki-67 proliferation indices. The prognostic significance of Simpson grade varied across anatomic locations, with clear associations observed for convexity and skull-base meningiomas, but limited relevance for parasagittal/falx meningiomas irrespective of WHO grade.
CONCLUSION
Simpson grading remained strongly associated with recurrence after GTR. These findings suggest that the extent of dural and bony clearance remains clinically relevant; however, Simpson grading should be contextualized within tumor biology and anatomic constraints. Future recurrence models integrating molecular and surgical variables may refine prognostic frameworks rather than current standalone classification systems.
MeSH
Neoplasms, Classification, Meningioma